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Home Health & Hospice Week

Beware Adjusted Claims Payment Problem

Published on Tue Aug 10, 2010

You can expect big delays to adjustment payments for some home health agency claims, thanks to a payment system glitch.  The problem: When the PC Pricer changes a HIPPS code on a claim upon submission and then you adjust the claim to change the code again, the claim pays at the originally changed code, regional home health intermediary Cahaba GBA explains on its website. The solution: A fix for this issue won't be in place until December, Cahaba says. Home health agencies can either save their affected claims until then, or submit adjustments for such claims on paper claim forms, Cahaba instructs. If submitting paper forms, you'll have to "include a remark on your UB- 04 adjustment stating that the adjustment is due to the HIPPS recoding issue." Submitting the paper form may not gain you much, however. HHAs must "allow up to 45 days for the adjustment to be entered," [...]
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